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General NPI Number Information
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NPI Number | 1073096335
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Entity Type | Organization
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Legal Business Name | TH WILSON NEUROMONITORING PLLC
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Dates
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Enumeration Date | 09/12/2018
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Last Update Date | 04/10/2019
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Provider Practice Location Address
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Address Line | 3536 HELEN AVENUE DR
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City | TERRE HAUTE
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State | IN
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Zip | 47802-3426
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Country | US
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Telephone | 800-310-7334
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Fax |
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Provider Business Mailing Address
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Address Line | DEPT 880285 PO BOX 29654
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City | PHOENIX
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State | AZ
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Zip | 85038-9650
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Country | US
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Telephone | 800-310-7334
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | G ANDREW WILSON
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Credential | MD
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Telephone | 800-310-7334
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204R00000X
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Taxonomy Name | Electrodiagnostic Medicine Physician
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License Number |
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License Number State |
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